Provider Demographics
NPI:1912985953
Name:PHYSICAL REHAB INC.
Entity Type:Organization
Organization Name:PHYSICAL REHAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-366-6090
Mailing Address - Street 1:1451 ELM HILL PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-4523
Mailing Address - Country:US
Mailing Address - Phone:615-366-6090
Mailing Address - Fax:615-366-6098
Practice Address - Street 1:1451 ELM HILL PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-4523
Practice Address - Country:US
Practice Address - Phone:615-366-6090
Practice Address - Fax:615-366-6098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4118977OtherTENNCARE (PHYLLIS)
TN3723757Medicaid
TN4093171OtherTENNCARE
TN3723757Medicaid